“These findings are concerning,” says principal investigator Edward Mills, professor in the Interdisciplinary School of Health Sciences at the University of Ottawa and Canada Research Chair in Global Health. “Wealthy countries are trying to strengthen the health systems of Africa and are providing essential medicines, but they are benefitting from Africa’s financial loss in training health workers that emigrate to the wealthier settings.”

The authors are now calling for destination countries to invest in training and health systems in the source countries.

“No one is saying that people should not be permitted to make decisions about where they live or want to succeed in their careers,” says Dr. Nathan Ford, a study author from the University of Cape Town, South Africa. “But how can we make progress in building health systems when local university budgets and school places are depleted by physicians who then go and work in a wealthy nation?”

The migration of health workers from poor countries contributes to weak health systems in low-income countries and is considered a primary threat to achieving the health-related Millennium Development Goals, says the study.

“While wealthy countries are benefitting from the doctors who choose to move, there is a responsibility to ensure we are not damaging local health systems in Africa,” adds study author Ivy Bourgeault, professor in the Interdisciplinary School of Health Sciences at the University of Ottawa and CIHR Health Canada Research Chair in Human Resources for Health Policy. “Some countries, such as the USA, have recognized this and pledged to train 130,000 new health staff in Africa; other countries, such as Canada, are providing much less.”

There is a critical shortage of doctors in sub-Saharan Africa, which has a high prevalence of diseases like HIV/AIDS. Mills and colleagues estimated the monetary cost of educating a doctor through primary, secondary and medical school in nine sub-Saharan countries with significant HIV-prevalence. The research team added the figures together to estimate how much the origin countries paid to train doctors and how much the destination countries saved in employing them.

The results show that governments spend between $21,000 (Uganda) to $59,000 (South Africa) to train doctors. The countries included in the study paid around $2 billion US dollars (USD) to train their doctors only to see them migrate to richer countries, say the authors. They add that the benefit to the UK was around $2.7 billion USD and about $846 million USD for the United States.

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